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Journal of the American Heart... May 2022Background Clinical prediction models have been developed for hospitalization for heart failure in type 2 diabetes. However, a systematic evaluation of these models'... (Meta-Analysis)
Meta-Analysis Review
Background Clinical prediction models have been developed for hospitalization for heart failure in type 2 diabetes. However, a systematic evaluation of these models' performance, applicability, and clinical impact is absent. Methods and Results We searched Embase, MEDLINE, Web of Science, Google Scholar, and Tufts' clinical prediction registry through February 2021. Studies needed to report the development, validation, clinical impact, or update of a prediction model for hospitalization for heart failure in type 2 diabetes with measures of model performance and sufficient information for clinical use. Model assessment was done with the Prediction Model Risk of Bias Assessment Tool, and meta-analyses of model discrimination were performed. We included 15 model development and 3 external validation studies with data from 999 167 people with type 2 diabetes. Of the 15 models, 6 had undergone external validation and only 1 had low concern for risk of bias and applicability (Risk Equations for Complications of Type 2 Diabetes). Seven models were presented in a clinically useful manner (eg, risk score, online calculator) and 2 models were classified as the most suitable for clinical use based on study design, external validity, and point-of-care usability. These were Risk Equations for Complications of Type 2 Diabetes (meta-analyzed c-statistic, 0.76) and the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (meta-analyzed c-statistic, 0.78), which was the simplest model with only 5 variables. No studies reported clinical impact. Conclusions Most prediction models for hospitalization for heart failure in patients with type 2 diabetes have potential concerns with risk of bias or applicability, and uncertain external validity and clinical impact. Future research is needed to address these knowledge gaps.
Topics: Diabetes Mellitus, Type 2; Heart Failure; Hospitalization; Humans; Models, Statistical; Prognosis
PubMed: 35574959
DOI: 10.1161/JAHA.121.024833 -
World Neurosurgery May 2022Classic randomized controlled trials (RCTs) form the cornerstone for medical guidelines and protocols. However, in neurosurgery, RCTs are not always applicable to...
BACKGROUND
Classic randomized controlled trials (RCTs) form the cornerstone for medical guidelines and protocols. However, in neurosurgery, RCTs are not always applicable to everyday clinical practice. Pragmatic controlled trials aim to incorporate real-life data with the preservation of the methodologic quality. This study is a systematic literature review of all pediatric neurosurgical RCTs published between 2000 and 2020 and an analysis of their pragmatism.
METHODS
An electronic database search was performed in PubMed, EMBASE, and the Cochrane Library to identify all relevant trials. Pragmatism was evaluated retrospectively on 9 domains: eligibility, recruitment, setting, organization, flexibility (delivery and adherence), follow-up, primary outcome, and primary analysis.
RESULTS
Of the 1862 studies included, 15 met the inclusion criteria. On average, studies scored between equally pragmatic/explanatory and rather pragmatic (M = 3.59, standard deviation [SD] = 0.56). Lowest ratings were seen for setting (M = 2.80, SD = 1.66) and eligibility (M = 3.20, SD = 1.66). Highest scores of pragmatism were given to analysis (M = 4.67, SD = 0.82) and intervention organization (M = 4.60, SD = 1.06). There was no significant difference between studies based on number of patients included, main subject, or publication year.
CONCLUSIONS
Pediatric neurosurgical RCTs scored reasonably well on overall pragmatism. In the future, there will be a greater need for pragmatic controlled trials in pediatric neurosurgery to bridge the divide between real-life data and reliable methodological quality. There is an opportunity to develop further applications of pragmatism tailored to surgical interventions.
Topics: Child; Databases, Factual; Humans; Neurosurgery; Neurosurgical Procedures; PubMed
PubMed: 35505562
DOI: 10.1016/j.wneu.2021.09.124 -
Sleep Medicine Reviews Jun 2022Sleep disturbances are a core feature of posttraumatic stress disorder (PTSD) and can affect PTSD onset, maintenance, and recovery. However, there is conflicting... (Review)
Review
Sleep disturbances are a core feature of posttraumatic stress disorder (PTSD) and can affect PTSD onset, maintenance, and recovery. However, there is conflicting evidence about the directionality of sleep and PTSD symptoms, particularly at the daily level. The current systematic review summarizes the literature on within-person associations between daily PTSD symptoms and sleep among trauma-exposed adults. We searched four databases using PRISMA 2020 guidelines. Of 2006 screened articles, six met inclusion criteria. Study sample sizes ranged from 30 to 202 participants, and studies assessed PTSD symptoms and sleep for 7-28 days. Two relatively consistent findings emerged: (1) shorter sleep and poorer quality sleep predicted greater next-day PTSD symptoms, and (2) greater PTSD symptoms predicted nightmares and poorer sleep quality that night. Individual study risk of bias was low to moderate. The current review provides initial support for a bidirectional association between daily self-reported sleep and PTSD symptoms. Potential clinical implications include targeting sleep via evidence-based PTSD interventions and using just-in-time adaptive interventions to disrupt the daily PTSD-sleep cycle. Findings also highlight areas for future research, such as the need to incorporate more objective sleep measures, examine PTSD symptom clusters, justify sample sizes and number of daily observations, and recruit more diverse samples.
Topics: Adult; Dreams; Humans; Sleep; Sleep Initiation and Maintenance Disorders; Sleep Wake Disorders; Stress Disorders, Post-Traumatic
PubMed: 35367721
DOI: 10.1016/j.smrv.2022.101623 -
Childhood maltreatment and sleep in children and adolescents: A systematic review and meta-analysis.Sleep Medicine Reviews Jun 2022Childhood maltreatment is a global problem with the risk of serious health consequences for children and adolescents, including sleep problems. Former systematic reviews... (Meta-Analysis)
Meta-Analysis Review
Childhood maltreatment is a global problem with the risk of serious health consequences for children and adolescents, including sleep problems. Former systematic reviews have examined the association between childhood maltreatment and sleep problems in adults, but no systematic review has investigated the literature on childhood maltreatment and sleep problems in childhood and adolescence. We published a protocol (PROSPERO: CRD42021225741) and conducted a systematic literature search using nine electronic databases. Upon duplicate removal, 1530 records were screened against the inclusion criteria, and 26 studies were included in the review. The most studied sleep outcomes were symptoms of insomnia, sleep duration and nightmares. The results showed significant associations between exposure to childhood maltreatment and insomnia symptoms (OR 3.91, 95%CI: 2.64-5.79, p < .001), shorter sleep duration (-12.1 min, 95%CI: -19.4 to -4.7, p < .001) and nightmares (OR 3.15, 95%CI: 2.38-4.18, p < 001). There was a considerable heterogeneity in measures and instruments used to examine sleep and maltreatment. Our findings highlight the importance of screening and intervening for sleep problems in children and adolescents exposed to childhood maltreatment.
Topics: Adolescent; Adult; Child; Child Abuse; Dreams; Humans; Sleep; Sleep Initiation and Maintenance Disorders; Sleep Wake Disorders
PubMed: 35313257
DOI: 10.1016/j.smrv.2022.101617 -
Surgical Endoscopy May 2022Since the conception of robotic surgery, remote telesurgery has been a dream upon which incredible technological advances haven been built. Despite the considerable... (Review)
Review
BACKGROUND
Since the conception of robotic surgery, remote telesurgery has been a dream upon which incredible technological advances haven been built. Despite the considerable enthusiasm for, there have been few published studies of remote telesurgery on humans.
METHODS
We performed a systematic review of the English literature (PubMed, EMbase, Inspec & Compendex and Web of Science) to report studies of remote telesurgery in humans. Keywords included telesurgery, remote surgery, long-distance surgery, and telerobotics. Subjects had to be human (live patients or cadavers). The operating surgeon had to be remote from the patient, separated by more than one kilometer. The article had to explicitly report the use of a long-distance telerobotic technique. Articles that focused on telepresence or tele-mentoring were excluded.
RESULTS
The study included eight articles published from 2001 to 2020. One manuscript (1 subject) described remote surgery on a cadaver model, and the other seven were on live humans (72 subjects). Procedure types included percutaneous, endovascular, laparoscopic, and transoral. Communication methods varied, with the first report using a telephone line and the most recent studies using a 5G network. Six of the studies reported signal latency as a single value and it ranged from 28 ms to 280 ms.
CONCLUSIONS
Few studies have described remote telesurgery in humans, and there is considerable variability in robotic and communication methods. Future efforts should work to improve reporting of signal latency and follow careful research methodology.
Topics: Humans; Laparoscopy; Mentoring; Robotic Surgical Procedures; Robotics; Telemedicine
PubMed: 35246740
DOI: 10.1007/s00464-022-09074-4 -
The Australian and New Zealand Journal... Oct 2022Borderline Personality Disorder (BPD) is frequently complicated by the presence of dissociative symptoms. Pathological dissociation is linked with earlier and more... (Review)
Review
BACKGROUND
Borderline Personality Disorder (BPD) is frequently complicated by the presence of dissociative symptoms. Pathological dissociation is linked with earlier and more severe trauma exposure, emotional dysregulation and worse treatment outcomes in Posttraumatic Stress Disorder and Dissociative Disorders, with implications for BPD.
OBJECTIVE
A systematic scoping review was conducted to assess the extent of current literature regarding the impact of dissociation on BPD and to identify knowledge gaps.
METHODS
Four electronic databases (MEDLINE, APA PsycINFO, EMBASE, CINAHL Plus) were searched, and English peer-reviewed studies with adults with BPD were included, following Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) extension for scoping reviews (PRISMA-ScR) 2018 guidelines.
RESULTS
Most of the 70 included studies were observational (98%) with first authors from Germany (59%). Overall, dissociation was associated with increased BPD symptom severity, self-harm and reduced psychotherapy treatment response; findings regarding suicide risk were mixed. Dissociation was associated with working memory and cognitive deficits, decreased pain perception, altered body ownership, no substance abuse or the abuse of sedative substances, increased fantasy proneness, personality fragmentation, fearful attachment, dream anxiety, perceived stress and altered stress responses, increased cumulative body mass index, decreased water consumption, several neurological correlates and changes in gene expression.
CONCLUSION
BPD with significant dissociative symptoms may constitute a more severe and at-risk subgroup of BPD patients. However, there are significant research gaps and methodological issues in the area, including the possibility of unrecognized Dissociative Disorders in BPD study populations confounding results. Further studies are needed to better understand the impact of dissociation on BPD course and treatment, and to clarify the most appropriate assessment tools for clinical practice. In addition, interventional studies are needed to develop dissociation-specific BPD treatments to determine whether targeting dissociation in BPD can improve treatment outcomes.
Topics: Adult; Borderline Personality Disorder; Dissociative Disorders; Humans; Hypnotics and Sedatives; Psychotherapy; Self-Injurious Behavior
PubMed: 35152771
DOI: 10.1177/00048674221077029 -
Sleep Medicine Reviews Feb 2022The efficacy and safety of dual orexin receptor antagonists (DORAs) for primary insomnia have been well verified in several large randomized controlled trials (RCTs)... (Meta-Analysis)
Meta-Analysis Review
The efficacy and safety of dual orexin receptor antagonists (DORAs) for primary insomnia have been well verified in several large randomized controlled trials (RCTs) over the past several decades. However, there have been few systematic comparisons of different DORAs, and the best DORA for insomniacs has remained unclear. Here, Medline, Embase, Cochrane library, and clinicaltrials.gov were searched for RCTs (through December 31, 2020) to evaluate different DORAs versus a placebo. We pooled data from 13 RCTs. DORAs were superior to the placebo in all efficacy outcomes except the subjective number of awakenings (P = 0.90), but also showed higher risks of somnolence, abnormal dreams, fatigue, and dry mouth (somnolence: P < 0.00001; abnormal dreams: P = 0.03; fatigue: P = 0.001; dry mouth: P = 0.007). No statistical differences were found between any two of the DORAs in terms of primary efficacy outcomes. However, lemborexant yielded the three-highest surfaces under the curve ranking area (SUCRA) values (78.25%, 96.25% and 89.13%). Taken together, we conclude that DORAs are superior to the placebo in terms of efficacy and safety measures.
Topics: Humans; Network Meta-Analysis; Orexin Receptor Antagonists; Sleep Initiation and Maintenance Disorders; Wakefulness
PubMed: 34902823
DOI: 10.1016/j.smrv.2021.101573 -
Sports Medicine (Auckland, N.Z.) Mar 2022The month of Ramadan will intersect with many football leagues' schedules over the next decade. Understanding the effects of Ramadan intermittent fasting (RIF) on...
BACKGROUND
The month of Ramadan will intersect with many football leagues' schedules over the next decade. Understanding the effects of Ramadan intermittent fasting (RIF) on physical performance is necessary to guide considerations for football players.
OBJECTIVE
The aim of this systematic review was to investigate the effects of RIF on physical factors in football players, and secondarily to consider the impact this may have on domestic club football leagues.
DESIGN
We conducted a systematic review using PRISMA guidelines.
DATA SOURCES
The online literature search utilized CINAHL (EBSCO), Cochrane Library, Embase.com, PubMed, and Scopus databases, and grey literature (all from database inception to May 2020).
STUDY SELECTION CRITERIA
Inclusion criteria consisted of studies of football (soccer) players, data collected during and/or around Ramadan, with injury and/or performance data provided.
RESULTS
The search yielded 11,226 studies. Twenty-two studies were included following a review of titles, abstracts, and full texts. Studies included some iteration of before-Ramadan, during-Ramadan, and after-Ramadan data. Common measures observed included ratings of perceived exertion (n = 8), sprinting (n = 7), sleep (n = 7), peak heart rate (n = 6), jumping (n = 5), Yo-Yo intermittent recovery tests (n = 4), Wingate anaerobic test (n = 3), field-specific tests (n = 3), and injury rates (n = 2). Decreased physical performance was commonly observed during late afternoon/evening testing (before breaking the fast) and with high-intensity exercise.
CONCLUSION
There appears to be a performance deficit related to RIF in Muslim football players. Studies should explore the effects of RIF on actual match demands. Due to the month of Ramadan emerging into league calendars, considerations should be made to accommodate Muslim football players who are intermittently fasting.
Topics: Humans; Athletic Performance; Exercise; Fasting; Islam; Soccer
PubMed: 34757593
DOI: 10.1007/s40279-021-01586-8 -
International Journal of Environmental... Sep 2021Wildfires present a serious risk to humans as well as to the environment. Wildfires cause loss of lives, economic losses, expose people to personal as well as collective... (Review)
Review
Wildfires present a serious risk to humans as well as to the environment. Wildfires cause loss of lives, economic losses, expose people to personal as well as collective trauma, and compromise the mental health of survivors. Sleep disturbances are highly prevalent following a traumatic event; however, their prevalence is not well established amongst those confronted by natural disasters such as wildfires. The aim of this systematic review is to synthesise the empirical findings pertaining to wildfires and the prevalence of sleep disturbances in the general community affected by this natural disaster. We searched EBSCO, PsychINFO, Medline, SpringerLink, CINAHL Complete, EMBASE, PubMed, Scopus and Cochrane Library between January 2012 and March 2021. Five studies met the inclusion criteria. Findings from this systematic review suggest that sleep disturbances, assessed one to ten months following the fires, are highly prevalent in wildfire survivors, with insomnia (ranging between 63-72.5%) and nightmares (ranging between 33.3-46.5%), being the most prevalent sleep disturbances reported in this cohort. Results also highlight the significant associations between sleep disturbances and post-traumatic symptoms following the trauma of wildfires. There is a possible link between sleep disturbance prevalence, severity of, and proximity to fires.
Topics: Dreams; Humans; Natural Disasters; Sleep Initiation and Maintenance Disorders; Sleep Wake Disorders; Wildfires
PubMed: 34639453
DOI: 10.3390/ijerph181910152 -
Cureus Aug 2021Parkinson's disease (PD) is a neurodegenerative disease caused due to the destruction of dopaminergic neurons and the deposition of α-synuclein proteins, known as Lewy... (Review)
Review
Parkinson's disease (PD) is a neurodegenerative disease caused due to the destruction of dopaminergic neurons and the deposition of α-synuclein proteins, known as Lewy bodies. Generally, the diagnosis of PD is centered around motor symptoms. However, the early recognition of non-motor symptoms such as autonomic dysfunction, sleep disturbances, and cognitive and psychiatric disturbances are gaining increased attention for the early diagnosis of PD. Rapid eye movement (REM) sleep behavior disorder or REM sleep behavior disorder (RBD) is described as parasomnia, which is a condition of loss of normal muscle atonia causing the person to act out vivid dreams and it has been seen to be associated with the misprocessing of intercellular α-synuclein leading to neurodegenerative diseases such as PD. This review's objective is to highlight the significance of RBD as a prodromal premotor marker for the early detection of PD. We used PubMed as our primary database to search for articles on May 2, 2021, and a total of 1849 articles were found in our initial search using keywords and medical subject heading (MeSH) keywords. Thereafter, we removed the duplicates, applied the inclusion/exclusion criteria, and did a quality appraisal to include 10 articles in this study. We concluded that the recognition and diagnosis of RBD are of paramount importance to detect early PD, and further longitudinal studies and clinical trials are of utmost importance to understand their correlation; also, treatment trials are needed to prevent the phenoconversion of RBD into PD.
PubMed: 34522507
DOI: 10.7759/cureus.17026